Falling Off a Cliff

Caitriona is visiting with her husband Dan, reuniting my favorite trio. She’s here to cover the protests against the Republican Convention as a stringer for the BBC.

The move from Tehran to DC has been hard for her. She’s been turned down for all health insurance coverage due to her “pre-existing medical condition”–the seven-month-old American, conceived in the Axis of Evil, who squirms in her belly. Here, where doctors pay huge premiums to insure against malpractice claims, it costs ten to fifteen thousand dollars to deliver a baby without fripperies like pain relief. A Caesarian costs fifty grand–and American doctors are quick with the scalpel even on women who aren’t too posh to push. Those are the price tags for _healthy_ births.

Forty million Americans have no health coverage. That’s 3.7 million more than when Bush took office. You can end up paying off an appendectomy for as long as a college loan or a mortgage. Cait has spent her first month back in America walking from hospital to insurance office to birthing center, trying to strike a deal, but there’s no room at the inn.

As she schleps her new belly and her tape recorder in the the New York heat, interviewing Republicans and ukelele-playing protestants, it must hard for her to stay out of the fight for health care and decency. There’s little common about decency.

This morning we were stopped on my block by a tall man who wanted to know if we were going to the rally. We said yes, even though my mouse arm was already numb to the shoulder at the prospect of yet another long day at the office keyboard. My protest has to stay personal and portable.

“That’s good! Make your voices heard!” he said. His voice still had a trace of the islands. He pointed at my “Run Against Bush” sticker and then at her bump. “You, I can see running. But honey, they’re goin’ to catch you!”
“She’s much tougher than she looks,” I explained.
We chatted a while, glad to share outrage with a neighbor. Then he said “But I don’t know _what’s_ going on with Kerry. He’s playing dead!”
“That’s exactly right! He’s just rolling over.”
“Playing _dead_. He won’t fight back.” He shakes his head. “But you know, when you’re falling off a cliff, you’ll take anybody’s arm that’ll save you. You can’t look too close at who it is.”

He handed us leaflets and wished us luck with the votes we don’t have.

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9 thoughts on “Falling Off a Cliff”

Malpractice suits against OB/GYNs rank no. 1. Average and total size of udgments against that speciality also rank no. 1. While not reallly related to your excellent overall comments, these are facts too often forgotten. “Bad babies,” the actual phrase used in the “industry,” can be expensive to doctors and hospitals.

That makes their malpractice the most expensive. It explains why some states have no commercial malpractice insurance available. A “bad baby” is defined as one that’s imperfect in virtually any way. Even the threat of a malpractice suit, or its investigation, is expensive.

This is one area where the conservatives and liberals, not to mention those caught in the middle, need to have a meeting of the minds. Tort reform, long a credo of the Republicans, and one opposed by Democrats (that’s how, after all, the Democratic candidate for vice-president made his millions and it was from those “in his business” who funded his primary campaign).

Polzarization causes stagnation in reform. When the two don’t talk to each other in the first place, or when a new proposal doesn”t take the concerns of both into consideration, the posturing and other sources of delay are inevitable. Of course if you’re a Liberal or a Conservative you can (conveniently) choose to ignore the views of the other, let alone consider compromise.

Kerry is painted a “tax and spend liberal,” Bush a conservative that won’t support needed health reform. That’s left your friend, five months pregnant, dangling in the middle. Like most of us. The number of Americans covered by health insurance has been halved in recent years. The half that still have it have increasingly high deductibles or co-payments, or less coverage than previously.

“Pre-existing condition?” Why should anyone expect an insurance company, established just like a startup software company for the purpose of making money, to “insure” against the inevitable? That’s not “insurance.” It’s an area funded only by some government program which handles the needs of special cases like hers (a “special case” being someone not employed by a large corporation prior to impregnation, as such coverage is increasingly rare in small business). And who pays for it? The employed share the additional burden of what should be a small minority of special cases.

Start defining those “special cases” in broad terms and the expense obviously rises. The U.S. has the best technology in the world in biotechnology. Yet the death rate for infants is lower in Scandinavian countries where there’s less technology but more hands on treatment, a smaller drug problem, and other advantages. But there are also cultural differences which make the same delivery systems untenable. For the U.S. to try to copy Swedan’s plan would be as inane as Sweden trying to use the one in Canada.

I agree, Jerry, that’s it’s unreasonable to expect insurance companies to take care of Caitriona. Why should they? It’s a terrible business decision–this is a person who will definitely cost them at least $10K this year, and likely more. (And the high rate of Caesarian interventions here is also related to fear of “bad baby” problems.)

It also seems weird and wrong that employers have responsibility for their workers’ healthcare. For small companies (and large), it’s crippling. As an employee, it makes me feel indentured. And those of us who are fit and healthy enough to work are probably least in need of health coverage.

Something’s broken. Tort reform will go a long way, but it’s not the full story. Back the Fifties, when Ireland was still a third-world country, the Minister for Health, Noel Browne, introduced the Mother and Child Scheme that guaranteed healthcare to every mum and child up to sixteen (against ferocious opposition from the Catholic Church). It was hugely ambitious, but it said something about the priorities of a dirt-poor country. We have not forgotten it.

Last year I had a miscarriage in Ireland and was looked after with great kindness and respect by an overstretched local maternity hospital. I was never asked for a credit card on several follow-up visits. The service was just chaotic enough that yuppies who can afford it buy health insurance for private care, but the basics were there for anyone, no questions asked. I probably didn’t need free care–I would’ve been willing to pay at least part–but I was proud that Ireland still puts that value on all forms of motherhood, even beyond special cases. Babies aren’t a luxury. 😦

BTW, I highly recommend Jessica Mitford’s “The American Way of Birth” as a great introduction to the politics of the birth industry. May she rest in peace.

Although I tend towards economically conservative, I think that the problems with private sector health care justify a State owned health care system, even without regard to fairness.

in either case, as Dervala mentions, it is going to be a tax. The healthy subsidize the unhealthy, and American corporations subsidize their workers. Effectively, a corporate tax.

Furthermore, the law is in California, at least, does not allow insurance companies to discriminate against the chronically ill, or pregnant women. Effectively they have privatized a socialist system, where everybody pays according to ability to , and withdraws according to need.

In fact, this is the same as what any State owned service would do, except the private companies cream off a profit, a profit that cannot be confused with a real profit created by a startup software company, as the insurance company is not really creating any wealth -just moving money around the place.

Of course, that is the only way that health insurance could work, or else the old, the chronically sick and the people who actually need it, would be priced out.

That is to ignore the 40 million uninsured, but my point is that a totally privatized system makes no sense even from a free market point of view. It clearly has to be more expensive for the same number of people covered.

The US philosophy on health care and guns differentiates it from the rest of the developed world: in the US you have a right to bear arms but it is a privilege to have access to health care. In the rest of the world you have a right to health care and it is a privilege to have a gun!

With regard to the Mother and Child Scheme: – The medical establishment skilfully manipulated the Catholic Church to do its dirty work on this!

BTW, it’s not just the end-users that pay out — the US *government* spends more on healthcare per capita than all other developed-world nations that the OECD tracks healthcare-spending data for, apart from Iceland and Norway.

There’s no doubt something needs to be done about this. But it’s become a repub-v-democrat hot-potato issue, and the healthcare industry has their lobbyists running in top gear, so I’m not holding my breath…

There was an unsuccessful challenge under NAFTA a few years ago — I forget if it was softwood lumber or automobiles — that argued Canada was somehow in violation of the agreement as our single-payer, non-profit medicare system was an “unfair subsidy”. Why? Because our cost structure is lower? Unfortunately the memory of life before government-funded, privately-delivered healthcare is fading. May we never revert to a time where illness could bankrupt an individual or family, or worse, preclude care.

John, in all the fuss here over seniors crossing the border to buy cheaper drugs in Canada, there’s been surprisingly little coverage of *why* drugs are cheaper in Canada. Most of my American friends assume that state-funded health systems are huge tax burdens. I don’t think they told how expensive this so-called free market is.

They ARE huge tax burdens — in fact, the single largest government expenditure in Ontario, and growing. However, the U.S. alternative remains more expensive per capita, with poorer aggregate outcomes for infant mortality, morbidity, life expectancy, etc. These outcomes are far more polarized stateside than any other ‘developed’ nation. Taxes are the price I pay for civilization, and civilization in turn allows me to live freely and fearlessly, without bending my knee to charity.